Care Navigators or Family Doctors?

Author: David Zigmond

In systems like the NHS where some people are paid much more than other people then it is always tempting to reduce costs by limiting the role of the most expensive people (doctors) and trying to introduce other people, at a lower cost, to do some of their work for them. Often the idea of screening people out or redirecting them elsewhere seems attractive. In this short article David Zigmond reflects on the potential disadvantages of this approach.

The Daily Mail reported that NHS England is training receptionists to act as ‘care navigators':

Patients trying to see a GP are being screened by receptionists in a controversial scheme designed to cut the number of appointments. Under an NHS drive to free up doctors' time, clerical staff are being trained as 'care navigators'. They are being sent on a half-day course and taught how to direct patients to other health professionals, including nurses, pharmacists or physiotherapists. The scheme was devised to reduce 'avoidable' appointments and is gradually being adopted by surgeries across England. GPs say up to a quarter of consultations are unnecessary and taken up by patients who could look after themselves at home or see another health professional.

I have worked as a GP for forty years and know that this proposal will not work: it carries too many misconceptions.

Much of frontline medicine is not straightforward or what it seems. Often it is unclear – at least at first – why people ask for help. While some complaints are visible or clearly serious, many are more obscure. Many are not ‘treatable’ in the simply understood sense – our stress-related, our ageing and our mental health problems, for example. Most of us have all kinds of fears or loneliness beyond our words or understanding. None of this is easy, but our better erstwhile family doctors could greatly help when they got to know their patients: they could then offer skilled and bespoke guided support, comfort and encouragement. This kind of professional contact does not quickly ‘treat’, but certainly helps us heal, cope and positively adapt, and probably prevents more serious illness.

But these kinds of consultations require subtle skills, knowledge and experience – not just of medicine but of the patient’s nature, their life and families. And these can only be provided from a service that offers easily accessed personal continuity of care. This can never be complete or perfect but the better old-fashioned family doctors used to be able to offer this kind of relationship far more readily than a current (likely locum and part-time) Primary Care Service Provider (as GPs are administratively designated).

Few patients now can even name their GP, let alone see the same one predictably. Recruiting receptionists to further fragment and deflect our already fragile and poorly accessed personal continuity of care will be counterproductive: it adds even more barriers and procedures to a service most of us find is already increasingly impersonal, unfamiliar and uncaring. All this will turn out more expensive, too. And more anxiety-prone. And more hazardous.

The authorities will assure us this will not happen; but it will.

Many articles exploring similar themes are available via David Zigmond’s blog here. David would be pleased to receive your feedback.